Clinical characteristics and histopathologic changes of morphea: A single-center, retrospective study of 137 patients

Background: The clinicopathologic correlations and prognostic risk factors for refractory disease in morphea (localized scleroderma) are poorly described. Objective: To investigate the association between clinical characteristics and histopathologic features of morphea and identify risk factors for refractory disease. Methods: We retrospectively reviewed the clinical and histopathologic features, treatment regimens, and clinical responses for 137 patients with biopsy-proven morphea from January 2008 to May 2019. Multivariate analysis was conducted to identify factors associated with poor treatment response. Results: We detected associations between the pattern and degree of sclerosis and the anatomic site of the lesion, as well as between severe inflammation and concomitant autoimmune disease. Additionally, both bottom-heavy sclerosis and increased inflammation were associated with functional limitations/clinical symptoms. Based on our multivariate analysis, we found that increased risk of poor treatment response was correlated with tissue eosinophils and basal pigmentation. Limitations: This was a single-center retrospective study. Conclusion: Skin biopsy samples could show specific features of morphea, including eosinophil infiltration and basal pigmentation, which may indicate the need for aggressive treatment and frequent monitoring.